At a loss - IBD, pancreatitis, UTI

I'm trying to sort things out - as to what problem is causing Gus to not eat. When he does eat, he looks like he is in pain afterwards.

So far the vet at the ER (Sunday night) and his regular vet think he has pancreatitis and just had an attack recently. They also think IBD because of the diarrhea which happened two weeks ago. He was on Metronidazole for 5 days. He doesn't tolerate antibiotics very well at all so he was on a low dose, but it stopped the diarrhea. We believe the pancreatitis is chronic as he is always on pepcid which helps.

He vomited after Clavamox Monday which was the reason for the change to Convenia. His urine has been sent to a lab to find out if we gave the right antibiotic.

I have a call into the vet because he vomited last night. He was so hungry that he did eat a little less than half a can of Turkey and Giblet when I got home. Afterwards I could tell he felt ill and later he got sick.

I gave him pepcid and what I had left of Cerenia which was only 2mm last night. He is back on Prednisolone which so far isn't helping much but we have only been back on it for three days at 3mm. He ate a little this morning - mostly licking the juice, but managed a little food. I also gave him a syringe of baby food because I wanted to make sure he had enough in him before an insulin shot.

I am on another board and they are telling me to switch to raw rabbit diet. I don't know if he has a food allergy, his BG dropped when I gave him Clariten when we suspected seasonal allergies - this was a couple months ago. I took him off it after 4 days because he was tired on it and I felt like there might be more going on.

I am just so scared right now because he has never been this sick for this long. He's always responded to treatments relatively quickly. I don't know if I'm doing the right things. I don't know if I need to give the current treatment with the Prednisolone more time. He was on this steroid once before when he stopped eating after surgery to remove 7 teeth and it turned things around pretty quickly. Of course I'm not thrilled with it because he is Diabetic. The vet says it is more important to get this turned around and have a few days of high BG than possible liver damage.

Thank you for any input you might have. I greatly appreciate it.
-Rachel and Gus

 

The does was ML. I wrote MM. Sorry, just very tired and stressed.

 

hi Rachel,
I wish I could help on the IBD but I can comment on the pancreatitis issues a bit.
I have 2 cats, both were affected.
Shadoe had frequent bouts and I was giving her pepcid BID plus fluids and also bupe orally or inject. She has had these bouts for as long as she has been diabetic.
Oliver has had a constant simmering fPLI number, always just under 4 every time he's tested.
I have always added lots of water in all of their foods, but it's not been enough.

I have started to give both B12 shots, along with gabapentin for pain BID, and Shadoe's bouts have completely stopped.
Our new vet suggested the B12 shots to help her inflammations as soon as I mentioned that she is forever having pancreatitis issues. I decided to give Oliver the shots as well, and they are both much improved.

I hope you can find answers for the IBD / UTI; ask your vet about the B12 shots, maybe they could help.

 

Have you read this post by a vet tech from the old FDMB? http://www.felinediabetes.com/phorum5/read.php?8,876722,876722
It includes all the standards of care, of which you are doing most, so my recommendation from having been through pancreatitis with Gandalf is to add sub-Q fluids. Keeping cats hydrated is always a challenge because by nature they are not water driven creatures, ever try to give a cat a bath? If they aren't eating or drinking, they get dehydrated faster.

Giving sub-Q fluids probably sounds even more daunting than insulin shots and BG testing, but it really isn't. One of the best online walk-throughs on how to do it is here: http://www.weirdstuffwemake.com/weird/stuff/pets/cats/sophia/catjuice.html You don't need a special table or bag hanging apparatus, a board over the bathroom sink and hook on a bathroom door will do. I like doing meds and fluids in my bathroom because it's a small space which some cats may find comforting, others may not, however. You will learn what works or doesn't work with Gus.

I don't know that I would insist on rabbit for raw food, but my experience convinced me that raw food was the way to go for pancreatitis and concurrent IBD. Gandalf went from horrible diarrhea to none and eating on his own in 2 days after beginning raw food during his first pancreatitis attack. We did not use steroids. We used premade raw turkey and chicken from Feline's Pride http://www.felinespride.com

Hope this helps. Pancreatitis is tough, it needs more supportive care than some ailments. Sounds like you are doing a good job.

 

Thank you all. I'm definitely looking at what long term care I need to provide for Gus to keep it under control.

We just got home from the vet and she changed his anti-nausea med. She thinks will help. He also got sub q fluids today.

I tried raw briefly and Gus liked it. It was Primal which unfortunately has vegetables in it although it is 1% carbs. I would have to order the one you mentioned - Feline's Pride as it isn't sold here. My vet is opposed to raw so I took him off it after she gave her explanation as to why she doesn't think it's a good choice. I need to do some more research and think about it.

 

Just curious, what was the vet's reason for opposing raw food? Glad he got fluids today. It is something you can do at home regularly, even 50ml a day can help.

Feline's Pride is 100% raw, no veggies or fillers. It is fully supplemented, which is important so they get the proper nutrients, like taurine. It comes in 2.5lb tubs, frozen, you can unfreeze in fridge, divide up and refreeze in to useable portions. I make each batch 1/2 cup or 3/4cup so it gets eaten quickly enough to not spoil. It is ground fine enough to syringe feed through a 60cc syringe, but it may clog occasionally.

You could also try appetite stimulants. Has your vet discussed those with you?

 

Hi Rachel,

I don't drop in here very often anymore, but I happened to check the forums today and saw your topic.

Fidget has bouts of pancreatitis too, marked by episodes of vomiting/runny stools. For the most part they resolve quickly (only occasionally needing antibiotics). She doesn't do antibiotics well either - especially clavamox - but she tolerated the metronidazole well. The only one we've have had good luck with is Baytril.

Anyway, about pancreatitis diets... since we switched Fidget to Fancy Feast Roasted Chicken canned food her episodes are much less frequent. This switch was based on advice I received here on FDMB, by the way. Someone told me that high fat diets tend to trigger bouts of pancreatitis in cats predisposed to it. FF Roasted flavors have a LOT less fat than other FF flavors, in addition to being low carb. For some reason the roasted chicken works well for her; the roasted turkey and beef is less effective.

Fidget eats twice a day, AM & PM, around shot time. Each feeding is one can of Fancy Feast Roasted Chicken. We do give her about a tablespoon of dry Feline WD (yes, I know, everyone hates Science Diet and dry foods are a diabetic no-no, but our vet suggested this for the fiber content and we find that even that little bit helps keep her stools more on the solid side). Then Fidget gets about a quarter of a can of Fancy Feast "fish and shrimp feast" several hours after her meal as a snack. (the fish is purely something we do to spoil her - she is 18 and has liver problems, so we're going for increasing her quality of life). During more serious bouts with the pancreatitis we often switch out the can of chicken for a can of the fish and shrimp feast (because it reduces her diet to one that has virtually no fat).

Anyway, I'm not specifically recommending that you try the Fancy Feast route, just suggesting that whatever you feed during the pancreatitis flares, make it very low fat. I suppose raw rabbit would be low carb, but I'm not sure about the fat content... I've always considered rabbit to be a very greasy meat. For most diabetic cats, watching fat content is not an issue. Just for our pancreatitis babies.

In the interest of fyi, it's just something to look for because every cat is different, but Fidget's blood glucose numbers tend to be much higher when she is dealing with the pancreatitis. It's like a neon sign for us, and we've sometimes been able to switch her to the all fish meals before she shows symptoms. It has made her flares much easier to manage and quicker to resolve.

Sorry for the wall of text, but I didn't want to leave out anything that might be helpful to you. I hope Gus starts to feel better soon!!

 

If you can call your vet, ask to get a fluids kit so that you can give fluids at home yourself. It's cheaper for you, and it's alot more relaxed a setting for your cat. Since you are already giving insulin shots, giving fluids will be a piece of cake for you.. think of it like watering your plants and how they seem to perk up afterwards... you will notice the same with your cat.
Check with your vet to find out how much fluids would be needed a day, and if a large amount, you can easily split the total a few sittings per day. One thing to keep in mind is that fluids can result in lower BG numbers, so if your cat's BG is low, you may want to wait till they are higher before giving fluids.

For the fat content, you could check Binky's list for food choices that are low carb and low fat.

 

Thank you so much for the information. I didn't know that fluids helped with pancreatitis. I thought they gave fluids because of the vomiting to rehydrate them. My vet did say the extra fluids would help with the UTI.

I am going to ask her about B12 for the future. See if it is something that will help him.

I'm just hoping the new medication is going to work for him. The reason the vet chose this medication is because he still seems interested in food, but he vomits it back up. She said we could try an appetite stimulant, but that the inflammation and nausea seem to be the culprits in her opinion. He isn't always interested in food, but sometimes he is so she thought if we get these other things under control then he will eat.

He did eat two tiny meals after stating the new med today. So far he has held it down and doesn't look like he was in as much pain as he has been. She said it is going to take time and I need to be ok with the fact that his appetite isn't going to magically return over night. I'm going to try to handle this. It's hard when they don't bounce back right away. I just need him to be ok.

 

Cats hide pain.
Pancreatitis painful, so please tell the vet you want some pain meds.
I believe that once your cat has had pancreatitis, odds are pretty good your cat will have other bouts, flares, so it's best to keep pepcid, fluids, and pain meds on hand for the next attack.

Once the nausea has passed, you could try giving 1/4 tab regular 10mg Pepcid twice a day; you may find less upset stomach issues.

 

It's good to see Gus making some improvements!

I didn't think to mention it, but Fidget gets subQ fluids at home too and feels noticeably better for several days afterward. Hers is because of her liver issues, but it makes sense that it could help with pancreatitis flares too. It keeps them hydrated, yes, but it also flushes bad stuff out of their system. Vicky's post is really good... I think that video was one I saw when I was considering home fluids for Fidget. It isn't as intimidating as it looks, and your vet should demonstrate how to do it. It is inexpensive, too, as treatments go. We pay $20 for the complete fluids kit (including 1liter of fluids, or 10 treatments - we do once or twice a week depending on how she looks).

I dislike steroid therapies too, but if Gus has any more issues keeping food down I'd have to agree that continuing the therapy might be worth the risk. The complications of the steroids seem less immediately dangerous to me than the complications from not eating. Hopefully, though, Gus is on the mend and won't even need to consider that. Cats are weird with tummy troubles. Sometimes they just get into vomiting cycles and need a little help getting out. Our civvie Sheba does that and has had to take steroid injections to clear it up.